THE SHEPHERD’S INN

Emergency Screening

Emergency Screenings may be conducted in the following situations:

Downtown Rising Drop-offs

When a City Employee brings an individual for emergency shelter.

Extreme Weather

Temperatures at or below 35 degrees, extreme heat, hurricanes, or other environmental disasters.

Other Extreme Situations

As specifically approved by your supervisor.

"(Required)*" indicates required fields

1Initial/Legal

2Health

3Guidelines

4Decision

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Client ID(Required)*

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Lastbeddate

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Today

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Days since last bed stay

The applicant was a client within the last 30 days.

Initial Questions

Staff Member Performing Prescreening(Required)*

First Last

This is a previous client.
Make sure you don’t write over their name with a new client.

Applicant Name(Required)*

What is your first and last name?

First Middle Last

Applicant Name(Required)*

What is your first and last name?

First Middle Last

Reason for Emergency Screening(Required)*

Emergency Weather

Other – With Supervisor Approval

Phone(Required)*

What’s a good contact number to reach you at?

Client does not have phone

SMS/Text Opt-In

I agree to receive text messages (SMS) from Atlanta Mission regarding important updates, appointments, and other operational information related to the services provided to me.

Do you have an email address you can share with us?

Birthdate(Required)*

Client refused to provide birthdate(Required)*

Yes

*Applicant is not qualified – Refused Birthdate(Required)*

The applicant refused to provide their birthdate. For security and identification purposes, all incoming client’s must provide a birthdate. Please select End Interview and press next.

End Interview

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Age(Required)*

*Applicant is not qualified – Unaccompanied minor(Required)*

The applicant is an unaccompanied minor. We cannot provide shelter to unaccompanied minors at The Shepherd’s Inn. Please select End Interview and press next.

Override

End Interview

Gender(Required)*

According to the applicant‘s Government-Issued ID

Male

Female

*Applicant is not qualified – Female applying to The Shepherd's Inn(Required)*

The applicant is a female. We cannot provide shelter to men at Restoration House. Please select “End Interview” and press next.

Override

End Interview

What is your race?(Required)*

American Indian/Alaskan Native

Asian

Black or African American

Native Hawaiian/Pacific Islander

White

I don’t know

I refuse to answer

What is your ethnicity?(Required)*

Are you a veteran?(Required)*

Yes

I refuse to answer

I don’t know

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Count of Active Bans

The applicant currently has an active ban. Click next.

, with this interview, I am trying to get an idea of what is currently going on in your life; so I will be asking some questions to guide that process. I encourage you to be as open and upfront with the information as possible.

Legal History

Search for in the National Sex Offender Registry.

Search the National Sex Offender Registry

*Are you a sex offender?(Required)*

Yes

The applicant is a registered sex offender. We cannot provide shelter to a registered sex offender. Please enter any notes in the box below and press next.

Have you been charged with any violent crimes?(Required)*

Yes

Can you tell me more about the violent crime?(Required)*

*Does the violent crime prevent entrance into Atlanta Mission?(Required)*

Applicants who are convicted of an armed crime or aggravated assault within the last 5 years, murder at any point in their lives, fire setting at any point in their lives, or rape at any point in their lives should be referred out to other partners. If they’ve made threats against others, make sure to speak to the Community Living Leader to confirm whether or not they can be accepted.

Yes

You’ve recommended that the applicant be referred out rather than continuing the interview. Please press next.

Is the applicant intoxicated or under the influence?(Required)*

Yes

The applicant is intoxicated or under the influence. We cannot provide shelter to an applicant who is currently intoxicated or under the influence. Please press next.

Please let the applicant know they may not use drugs or alcohol on the property or be intoxicated on or off the property.

Safety

Are you fleeing from someone?(Required)*

Yes

Are you in immediate danger?(Required)*

Would the applicant‘s presence on campus be a safety issue for the rest of the clients because of the danger they face?

Yes

*Applicant is not qualified – Applicant in immediate danger(Required)*

Applicant is in immediate danger of abuse or being stalked cannot be accepted. Please select “End Interview”, enter in any notes in the box below, and press next.

Override

End Interview

Are you willing to not tell the person you're fleeing from that you are coming here?(Required)*

If the applicant answers yes, let them know that if their abuser or stalker shows up here looking for them, they will be referred to Gateway for their own safety and the safety of the community.

Yes

*Applicant is not qualified – Applicant would share location with abuser/stalker(Required)*

Applicants planning to share their location with their abuser or stalker cannot be accepted. Please select “End Interview”, enter any notes in the box below, and press next.

Override

End Interview

Safety Notes

*End Interview?

Only check if you are denying the applicant.

End Interview

Physical Health

Are they able to stand, sit, walk, etc without assistance?(Required)*

Yes

The applicant cannot stand, sit, or walk without assistance. We cannot provide a cot to someone unable to sit down and stand up. Please press next.

Physical Health Notes

Mental/Behavioral Health

Does the applicant's mental health appear to be stabilized?(Required)*

Evaluate whether they seem to be a threat to self or others, if they can comprehend instructions, are aware of their current state, and what their agitation level is. If they do not appear to be stabilized or aware, you could ask them, “Do you know where you are?”

Yes

You’ve recommended that the applicant be referred out rather than continuing the interview. Please enter any notes in the box below and press next.

Mental/Behavioral Health Notes

COVID-19

Have you been diagnosed with or been exposed to anyone with coronavirus in the past 14 days?(Required)*

Yes

*Applicant is not qualified – Applicant has exposure, diagnosis, or symptoms of COVID-19(Required)*

We cannot currently serve applicants diagnosed with or exposed to COVID-19. We also cannot serve applicants with current symptoms of COVID-19. Please let them know they will need to wait 14 days before rescreening and will need to have proof of a negative covid test before coming in. Please select “End Interview” and press next.

Override

End Interview

TB

Do you have a cough that has lasted for 3 weeks or more?(Required)*

Yes

Have you had contact with person(s) with chronic cough recently?(Required)*

Yes

Have you lost weight without explanation during the past month?(Required)*

Yes

Have you coughed up blood in the past month?(Required)*

Yes

Have you been more tired than usual over the past month?(Required)*

Yes

Have you had fevers almost daily for more than one week?(Required)*

Yes

Have you sweated so much during the night that you've soaked your sheets or clothing during the past month?(Required)*

Yes

*End Interview?

Only check if you are denying the applicant.

End Interview

Guidelines

Now, I’m going to read you our guidelines and confirm that you agree to abide by them.

Atlanta Mission strives to maintain a safe community. As a result, all clients are expected to uphold the following safety guidelines at all times:

We highly encourage you to participate in services to get all you can out of your stay with us, however, you do have the option of leaving between 8:00 am-7:00 pm daily. You must have an approval in order to leave campus outside of those times.

Do you agree to abide by our guidelines and fully participate in services?(Required)*

Yes

*Applicant is not qualified – Refusal to abide by guidelines(Required)*

We cannot serve applicants who refuse to participate in our services and abide by our guidelines. Please select “End Interview” and press next.

Override

End Interview

Closing Tasks

General Notes

Intake Decision(Required)*

Planned to accept the applicant?

If so, you have not answered all required questions.

Press the Previous button and unselect “End Interview” or the Disqualifying question and finish the interview.

Denial Reason(Required)*

Select the reason that was denied entry

, thank you for your interest in staying at Atlanta Mission. Due to the information you shared, , we are unable to serve you within our facility at this time.

Because we are unable to help, there may be another facility that could better assist you, I will send that information to your email/phone and we’ll work with you to find a solution.

Referrals(Required)*

Salvation Army: 404-486-2700. 469 Marietta Street Atlanta, GA 30313.

Gateway: (404) 215-6600. 275 Pryor Street SW Atlanta, GA 30303. They are not a shelter but they do referrals for other shelters as well as a housing assessment. Some shelters actually require their referral.

Must Ministries: (770) 426-7667. 55 Elizabeth Church Rd, Marietta, GA 30060.

The Atlanta City Baptist Rescue Mission: (404) 577-3409. 316 Peters St SW, Atlanta, GA 30313.

Lost and Found: (678) 856-7825. They accept ages 13-25. 24/7 phone hotline.

Covenant House: (404) 589-0163. 1559 Johnson Road NW, Atlanta, GA 30318. They accept ages 18-24.

Nicholas House: (404) 622-0793. 830 Boulevard SE, Atlanta, GA 30312. For families only. Requires a referral from Gateway.

Zaban Paradies Center: (404) 872-2915. 1605 Peachtree Rd NW, Atlanta, GA 30309. Shelter for Couples.

The Potter’s House: https://atlantamission.org/tph.

Atlanta Recovery Center: 404-577-3352.

Free Rehab Centers: 1-888-501-8982.

St. Jude Recovery Center: (404) 874-2224. 139 Renaissance Pkwy NE, Atlanta, GA 30308.

MARR Inc.: (678)-805-5131 or (800)-732-5430

Anchor Behavioral Health: (678) 251-3200. 5454 Yorktowne Dr, Atlanta, GA 30349.

Mercy Care: (Medication Resource), (678) 843-8600, 424 Decatur St SE.

Good Samaritan: (Medication Resource), (404) 523-6571, 1015 Donald Lee Hollowell Pkwy NW.

CAPN (Community Advanced Practiced Nurses): (Housing Resources for those with a behavioral health diagnosis and have experienced at least a year of homelessness), (404) 658-1500, 173 Boulevard NE, Atlanta, GA 30312.

PATH (Operates through Mercy Care): (Housing Resources for those with a behavioral health diagnosis and have experienced at least a year of homelessness), (678) 843-8600, 424 Decatur St SE, Atlanta, GA 30312.

Restoration House: Admissions screenings will take place by phone every Monday through Wednesday from 8:00 am – 10:00 am. Please call 404-588-4007 and expect to leave a voicemail.

Take the Client’s Photo for their ID Badge

1. Make sure the Logitech webcam is plugged in.
2. Open the Camera App on your laptop.
3. Aim the Logitech camera at the new client.
4. Click the take photo button in the Camera App.
5. After the screening is completed, upload the file to the client’s files in Salesforce.

How can I pray for you?

Please only click the Submit button once. It may take a few moments to process the submission.

Unique ID

THE SHEPHERD’S INN

Emergency Screening

Initial Questions

Legal History

Search for in the National Sex Offender Registry. Search the National Sex Offender Registry

Safety

Physical Health

Mental/Behavioral Health

COVID-19

TB

Guidelines

Closing Tasks

Take the Client’s Photo for their ID Badge

Search for in the National Sex Offender Registry.

Search the National Sex Offender Registry